Dr. Walter Willett: Chat with the World’s Most Influential Nutrition Researcher

JONATHAN: Hey everybody, Jonathan Bailor back with another SANE show and dare I say, the single most anticipated show I personally have ever recorded because we are here literally with the world’s most influential nutritionist, he is actually the second most cited researcher in clinical medicine and he has authored more than 1,500 scientific papers. He has been a great influence on my life and he’s changing and improving the lives of millions of folks and he’s got a new book coming out so he’s sharing his time and expertise with us today – the Chair of the Department of Nutrition at the Harvard School of Public Health, Dr. Walter Willett, welcome to the show.

WALTER: Thank you and good to be with you.

JONATHAN: Well, again, that you Dr. Willett for joining us and I’m very excited by your new book, which we have here, advanced review copy, “Thinfluence” and you have been for many, many decades saying that bad dietary advice is really one of the challenges that has led to the obesity epidemic. We’re being told bad information, but now you’re taking it one step further and saying that the environment itself is toxic and leading to obesity and you go so far as to say that your weight is not your fault in this book. Can you explain that a little bit?

WALTER: Sure. As you mentioned a lot of our research or most of my research over the last 30, 40 years has been focused on very specifically what we put in your mouths influences our long term health and wellbeing and of course lacking physical activity as well, that’s also very important.

When we look around, we find that the vast majority of people are not consuming an optimal diet. Now, some of that has been because they’ve been getting advice that’s been in the wrong direction and actually harmful, for example, the advice to not consume nuts because they’re high in fat or in fact, nuts are one of the healthiest things we could be consuming, but bit by bit we’ve been getting that advice and guidance straightened out. The guidelines are slowly shifting in the right direction, but still most people are not putting an optimal diet into their mouth and not being as healthy and happy as they could be in the long run, so when we look around and ask the question, why is it that people aren’t eating optimal diets, the answer is very complex and we realize that people are not acting in isolation, that all our decisions are heavily influenced by many factors around us and all too often in the wrong direction. So, this book puts together a lot of what we’ve learned about the influences on people’s behaviors and particular diet that happens at multiple levels, family level, community level, worksite level, friends of course, but then you go beyond that, the environment that we’ve created in our cities and our states, in our country as a whole has been adverse with regard to both diet and physical activity and we even go nationally and internationally. We see very strong forces International trade agreements, small time national corporations, all of those have major influences on what we eat, what our kids eat, what our nation eats.

So, what we’ve done is try to take this information and sort of start from the inside — most of the academics have looked at this sort of from the outside and seeing how this works, but let’s reverse this and say you, me, we’re sitting in the middle of all of these factors that are surrounding us and influencing us often in an adverse way and guide individuals to analyzing their own situation. It’s not the same for all of us. Almost everyone has a unique set of factors and influence what they eat. We help people look at their family and friends, worksite and then analyze ways that they might change that environment or where they can’t change it to do end-runs around it so that they could become more in control. This is really meant to be an empowering book that helps people deal with the many influences that too often push us in the wrong direction.

JONATHAN: I’ve really been enjoying the book Dr. Willett because you are so right that the environment plays a huge role here and I’m curious – an analogy I’ve sometimes used to help people to understand how multi-faceted and complicated this challenge is as I talk about – I compare it to a psychologicalchallenge, maybe such as depression where an individual walks into an office of a psychiatrist and says, doctor, I’m depressed what can I do and the doctor says, you just need to try harder to frown less and smile more and that’s kind of missing the point, isn’t it?

WALTER: Right. Things like our mental status and mental state are heavily influenced in the same way, so that’s a good analogy and there is fortunately understanding some of these factors can help us improve our own diets and diets of our family and in some ways this is a little bit of a recruitment book to get people aboard in helping us change some of the factors that adversely influence all of us together. In some ways we’re all in this similar boat here, each boat is a little bit different, but there are some big powerful factors that are pushing this all in the wrong direction.

JONATHAN: Dr. Willett, do you ever see a world – so for example, a 100 years ago, let’s say, give or take, everyone smoked. Everyone smoked, everyone smoked everywhere, if someone offered you a cigarette and you said, no, it would probably be thought of as rude. Today if someone offered you a cigarette and you said I don’t smoke, no one would think anything less of you, but today if you’re at the workplace or at someone’s house as you talk about in the book, and someone offers you some insane sweet processed garbage edible nonsense, saying I don’t eat those types of things can be a challenge because it’s perceived as rude. Societally can we ever overcome that?

WALTER: Yeah. I think we can and as you say, social (Inaudible 00:6:28) change. They don’t change overnight, it’s taken us 40 years to get to where we are in the smoking situation, but that’s changed like night and day compared to what it was. It used to be that I’m might have been sitting here talking to you with a cigarette in my hand. I was a student, in fact, I even sold cigarettes in the University hospital in the University of Michigan when I was a medical student.

JONATHAN: Oh, wow.

WALTER: We were filling in – the Honor Society filled in the lunch break of the person selling tobacco at the kiosk at the entrance to the hospital. Just unimaginable.

So if we change smoking we can change little (Inaudible 00:7:03) behaviors and I think we’re already seeing that, that there are I think in many communities, you would not be — it would not be accepted at a birthday party to give kids soda where that was just a norm just a few years ago, so those kinds of norms are already changing, but it will take a lot of work, diet is a lot more complicated than smoking, but this book is to help people analyze their situation and for example in this situation that you just described, you’re offered something that’s going to be harmful to your health, there are certain things you can do, blame it on your doctor, my doctor really would like me to stay away from those things. That’s always a good way — one way to deal with that and then in the longer term when the situation is reversed, offer some alternatives to your friends who then are healthy and support their better choices and their health.

JONATHAN: Dr. Willett it’s so funny that you mention the doctor’s orders because that’s literally the easiest way I’ve found and it’s sometimes I even tell a little white lie, I’m not diabetic or pre-diabetic, but if you quickly want someone to leave you alone about turning away a sugary treat, tell them you’re diabetic or pre-diabetic, they won’t press you anymore.

WALTER: Yeah, so we’re on all the road — where the vast majority of us are on our way to being diabetic unfortunately in this country and that very few of us have optimal glucose metabolism.

JONATHAN: Well maybe Dr. Willett you could help to coin a new term which is like pre-Diabetes which is like all of Americans so that we could say, I’m pre-pre-diabetic so I can’t eat that anymore.

WALTER: Yeah, anyway the point you make is right — that we can blame it on our doctor is a good thing to do.

JONATHAN: So, you mentioned Dr. Willett that nutrition and eating is certainly complicated and one of the things you touch on in the book — there’s a special section that says, everyone says to eat healthy, but what is healthy? You ask ten people, you’re probably going to get ten different answers. You’ve spent a lifetime, published more papers than probably anyone in the history of the world on the subject and one of the things you call out specifically is juice. And this is something that I think parents often with the best of intentions say, I’m going to give my kid fruit juice. Tell us about juice.

WALTER: Yeah, that’s a good example of something that sounds good and in small quantities juice could be fine. Back in the 1940s when scurvy was a real problem in this country, having a small glass of orange juice in the morning was a way that we actually helped reduce scurvy in the United States, but the problem is that now that people consume juice like a regular beverage and in fact, I was consuming a lot of juice some years ago and wanted take off a few pounds and sort of looked around my diet to see where my calories were coming from and I was astonished I was getting somewhere over 500 calories a day just from juice and cutting that out was a simple thing to do.

The reality is that juice has just about the same number of calories per glass as does Coca Cola and it will have a very similar adverse metabolic effect as drinking a soda. So, the problem is that it’s like if you’ve squeezed oranges to make a glass of orange juice you realize that it takes about three oranges to do that and you almost never sit down and eat three oranges one on top of the other, but it’s just so easy to put down that glass containing three oranges, lots of sugar, natural sugar, but just too much of it at one time and then go for another glass, so what we do see is that juice is related to more weight gain and higher risk of Diabetes.

JONATHAN: You mentioned that a glass of juice and a glass of Coca Cola, for example, could have the same number of calories and have the same negative metabolic impacts. Coca Cola is famous or infamous maybe — they have these billboards that say it’s only 140 calories. Is it the calories in juice and Coca Cola that’s hurting us or is it the sugar or something else?

WALTER: It’s both. First of all, that’s 140 calories in a 12-ounce can, unfortunately, 20-ounces has become a standard in many places around the country and I’m told that there are areas where 30-ounces is standard serving size for soda. So even 140 calories is quite a bit, but the trouble is many people consume many more servings per day than just that, but also this form of calories is really an adverse form of calories which of course has no nutritional value and provides our body with a sudden big blast of sugar. It has both glucose and fructose in it and in pretty much equal proportions and that alone has adverse metabolic effects even if it doesn’t contribute to weight gain.

JONATHAN: Fascinating, fascinating. Well, speaking of sugar and areas when it comes to healthy, maybe being complicated, you have said a lot of things about whole grains and research has shown whole grains being clearly beneficial from refined grains. There’s a lot of press nowadays about wheat specifically and the impact neurologically, as well as metabolically and the fact wheat we eat today is not like the wheat we ate in years past, but wheat, whole grain wheat is a whole grain. What are we to make of whole grain modern wheat?

WALTER: Yeah, I think from what we see whole grain modern wheat is still on average beneficial and of course especially if you’re comparing that to refined wheat and in nutrition it’s almost always important to look at what comparison we’re making.

JONATHAN: Absolutely.

WALTER: So, better to have that wheat in a whole grain form rather than a refined form and there are clearly some people about one percent of the population that is clinically sensitive to gluten and that’s getting a lot of attention, but that’s quite a small percentage for those people who are, it’s extremely important to avoid gluten. It can be fatal actually if people continue to consume gluten in their diet. It is a really serious condition, but it’s completely controlled by avoiding gluten. Alot of other people say they feel better when they’re on low gluten diets and many of them probably do because they’re cutting out big chunks of their diet if they’re really avoiding gluten, most of that has been coming usually from refined forms so wheat and other grains that do contain gluten and so when they eliminate that high amount of refined carbohydrate, yes, they will feel better, but it’s not necessarily because they’re sensitive to gluten.

So, I think from everything we see the vast majority of people can consume wheat if it’s in a whole grain variety and here again, there’s differences in whole grains. Things can be called whole grain if they’re finely milled and all the bran and the germ is still there, that is technically a whole grain, but the best form of whole grain is where the kernels are still intact, like this would be wheat berries for example, where the bran encapsulates the starchy endosperm and it creates like a sustained release capsule. So, our digestive juices don’t get at that starch particles as quickly when they’re encapsulated in the bran or on the outside, so the more we take that whole grain and pulverize it into fine particles the more rapidly we digest that and convert it to blood sugar, so there’s a spectrum of how beneficial whole grains are.

JONATHAN: Speaking of that spectrum and early in that very informative answer you mentioned that relativity is so important in nutrition conversations, saying is diet soda good for you, well relative to what, right? Relative to what? So, a lot of people, in my personal experience Dr. Willett, I found that oftentimes people will use grains – they’re almost crowding out vegetables with grains. I mean a lot of Americans they’ll have a serving of protein and then you’ve got to have your starch and there’s no vegetables on the plate. If someone were to crowd out grains with a lot of vegetables, how’s the relativity there, like let’s say I just even wiped all the grains off my plate and just stacked it full of vegetables, would that be a good relative trade off?

WALTER: Yes. Now that probably would be. The reality is that it’s maybe hard for a lot of people to have that many vegetables, getting people to increase by one or two servings a day is a challenge. One thing we know is that the grains are not essential for sure in a diet, but if we replaced them all with sugar that would be even worse, so that to make a point about relativity being important, but even carbohydrate in general is not essential as a nutrient. We have essential fats, we have essential proteins, amino acids and proteins, but grains and carbohydrate in general are not essential and it would be fine if people did replace all of the grain with a wide variety of vegetables, so that is good news, a wide variety of options that can be healthy, not just a single sort of exactly one style of diet.

JONATHAN: And if we take your decades of research around fat, what really excites me is that a lot of people may not like vegetables raw or just steamed, but what you’ve shown over many, many, years and many, many papers and I would imagine you’ve gotten some push back on this — is that there’s a lot of really healthy fat out there so if you start eating vegetables with some delicious fat, healthy fat added to them, it can become a lot easier to become green.

WALTER: Yes, absolutely and my Greek friend, Scott, told me that – and they have the highest vegetable consumption in the world and most of that – almost all of those vegetables are floating or swimming almost in olive oil and this is really all American — that Thomas Jefferson, a really interesting person, a brilliant scientist, as well as the author of our Constitution, was almost a vegetarian and extremely interested in botany and growing edible vegetables, so if you go to Monticello, you’ll see places where he grew vegetables, bringing a lot from the old world trying new vegetables, brought in plants from the new world that would be edible and he realized that to make them edible you needed oil.

So he desperately tried to produce olive oil in Virginia and couldn’t, so he had to bring olive oil from Portugal and had a whole room in his basement for olive oil storage until he found actually that from the slaves he got seeds to grow sesame plants and produced sesame oil, which did make it possible to produce oil in the new world, that it also has a nice flavor. So this is nothing new, people have known for a long time that adding some oil to vegetables will enhance their palatability and make them much more enjoyable.

JONATHAN: I think if we simply could reintroduce some of those concepts and I know you’re trying to do that, but you take olive oil and I want to talk about coconut oil too if we can and some fresh pressed garlic and you sauté up kale, I mean you try to eat kale by itself. That’s kind of hard. Do what we just talked about, yeah, you can fill your plate with that all day it seems.

WALTER: Absolutely. Adding that combination of garlic and olive oil and there’s a thousand other ways you can jazz up greens and make them much more interesting. Throw in a few nuts, that’s actually really has a nice combination as well.

JONATHAN: Well speaking of nuts and oils and fats, so a form of fat that’s been getting a lot of press recently is coconut and coconut oil and this made news ten years ago as being the devil, right? It was movie theater popcorn is popped in and it was oh, my gosh and today it seems to becoming back and we talk about medium chain triglycerides so, but coconut oil very, very high in saturated fats, but is plant based. What say you when it comes to coconut oil?

WALTER: The reality is that we don’t have any long term studies of people consuming regular high amounts of coconut oil as their primary fat in their diet so a key piece of the evidence is missing here. There was sort of a fad about palm oil, like this, about 20 years ago, so with Dr. Campos in our department taking the lead we did a study in Costa Rica and where they have both palm oil and other oils and we showed that palm oil wasn’t the best oil, that actually soybean oil, which is more unsaturated was superior for heart disease risk, as well as producing better blood lipids.

So, I am not jumping aboard the band wagon for coconut oil as the primary fat in the diet. Of course I love the flavor in certain dishes like Tai dishes and some other kind of Asian kind of dishes — that have coconut flavor is great and I think we should use it when we want that special flavor, but if you look at how it affects blood cholesterol fractions and include the fact that it does medium chain triglycerides do help boost HDL cholesterol — still coconut oil does not look as good as olive oil and the other more unsaturated oils, so until we have evidence to the contrary, I would not make that a basic everyday oil, just something to be used when you want that special flavor.

JONATHAN: And it seems like one of the underlying challenges that folks are trying to address with coconut oil, just discussing it academic type settings, you’ve come out over and over again just saying, look, baseline saying eating fat makes you fat and that eating fat causes the obesity epidemic, like you’ve said that is not true, that is patently not true, but there’s another step that some of your peers have taken in terms of saturated fat — the Mozaffarian and Ludwig, who came out in the Journal of the American Medical Association and said, look, saturated fat, there’s really little relation to heart disease in most prevailing dietary patterns. Do you personally share that thought or are you still on the fence a little bit about saturated fat?

WALTER: Well, I think we all agree and definitely Dr. Ludwig and Mozaffarian are close colleagues of mine and we all agree that if you compare – it all goes back to the relativity issue again – if you compare saturated fat with the rest of the calories in our diets, it’s about similar , but then you look – I wondered about this a few years ago and then took a look, well, what is in the rest of the American diet, what is comprising of the rest of the calories and you take a look. It’s refined sugar, refined stock, some trans fats and so when you’re doing that kind of analysis, comparing saturated fat with everything else, the comparison is a pretty bad (Inaudible 00:22:47) calories actually, so you’re sort of comparing bad with bad and it doesn’t make too much difference, but if you replace that saturated fat with polyunsaturated fats or some combination of monounsaturated and polyunsaturated fats like you’d find in almost all of the natural cooking oils, so it’s olive oil, soybean oil for example, canola oil, that tradeoff is going to be beneficial and I think we all agree about that so, I think looking at saturated fat versus everything else, or saturated fat versus carbohydrate, saturated fat doesn’t seem to make much difference, but that’s only half the story and the other half of the story is that if we replace that saturated fat with healthier types of fat that will be a good tradeoff.

JONATHAN: I think that’s such an important take home for the listeners and the viewers is that questions like is X good or bad, is it — I mean there are some trans fats bad, high fructose corn syrup, bad, relative to anything, but we’ve always got to ask that question about relativity and speaking about relativity, what about different peoples’relative health, so let’s for example, if I’m a diabetic, Type 2 Diabetic, what would be the biggest differences in the way you’d recommend that person eats versus someone who is otherwise metabolically healthy?

WALTER: Well, of course if someone is a diabetic and especially if they’re on insulin or other kind of glucose lowering therapy they definitely need personal guidance from their health care provider and maybe a dietician to make sure that they keep their medications insulin or other glucose lowering drugs in balance with the diet, but in a very general way, from what we’ve seen, the same healthy diet that’s good for someone without Diabetes is going to be in general healthy for a diabetic as well, in fact, it becomes even more important for a diabetic person because they are at higher risk of cardiovascular disease and so having healthy forms of carbohydrate, healthy forms of fat, plenty of vegetables, low amounts of high glycemic foods, all that will help control blood glucose levels and reduce cardiovascular disease risks.

So, there’s fundamentally no important difference in the diet that we would see be beneficial for a diabetic versus someone without Diabetes, but again it’s even more important for someone with Diabetes, especially the carbohydrate quality and amount become even more important.

JONATHAN: You mention there that high quality fats versus low quality, the high quality carbohydrate versus the low quality carbohydrate – you are an expert in observational studies. You’ve done lots of observational studies, so how often – when we talk about animal products, a lot of things are said about animal products and in a lot of observational studies, you’ll have a group – and this is an over-simplification, so bear with me here – you’ll have a group of people who eat hot dogs and spam, garbage like everyone agrees that those are garbage animal products compared with the group of people who eats less hot dogs and processed toxic spam and more vegetables and we’re like, oh, well, clearly that group had better health outcomes and then the media attributes the negative health outcomes to any form of animal product, which that seems like the whole thing we did with fat 50 years ago where it’s all fat is bad, throw it under the bus, what’s going on there?

WALTER: Well, as you say, there’s lots of – the comparison is that huge important issue here and I think with animal products we do have a spectrum again that on one end of the harmful spectrum would be the processed meats and those have not just the meats, but lots of sodium nitrates added to them, other things that sometimes we don’t even know about and then we have what we might call fresh red meat, which would be your steak, something like that and that we still do see if we compare it to other forms of animal products such as poultry or fish we still do see increased risks of heart disease and Diabetes, so and then we have again healthier animal products, especially fish which has essential Omega 3 fatty acids and then poultry looks pretty good actually.

If you look at the fat composition in poultry, it’s about 25 percent polyunsaturated fat compared to less than 5 percent in red meat, so it’s not surprising that poultry looks better, but then still nut’s whatreally the best of all and beans probably in the similar category as nuts are, so there is a spectrum and in general people will be — from everything we can see better off consuming more of their protein as in the form of nuts like in some fish and some other amount of poultry. The worst of processed meats and the fresh red meat that’s somewhere in between, but so there’s no one all bad or all right, it is like a lot of things, a spectrum.

JONATHAN: And so, in getting back here to the book again which is called, “Thinfluence” and if you look science, plenty to easy to digest science in here and that’s what I like, you’ll hear something which I read it, it sounds a little like, wait a second and then actually, it’s from this study and yada-yada-yada, which I’m a big fan of and in talking about again the cultural factors here, a lot of times when it comes to our health, we look to other people, we say, oh, there’s Sally, and she’s thin and not diabetic so what is she doing, let me follow what she’s doing. How much of this is personal, how much of it should we ask random people about, what are your thoughts?

WALTER: I think as you say, there’s a lot of this is about personal interactions and again, there’s layers and layers of that even within our own family they’re of course the most powerful influencers and sometimes they can be sabotaging, our good intent, and other times they can be highly supportive, so recognizing those differences and working around some of the adverse influences and try to spend more time with people who are supporting our wellbeing, we can see that at the worksite, we can see that in friends, as well as family, so a lot of this is an individual basis, but then beyond that there are larger factors too that at the worksite, what the company organization is providing, if the cafeteria makes a big difference, what’s in the vending machines makes a big difference, whether there’s encouragement to be active. Corporations are starting to get to recognize that actually they have a pretty big influence on their employees’ health and wellbeing and realizing it’s in many corporations are really becoming quite proactive in promoting health of their workers because they can see the bottom line benefits of that and it’s a win-win situation. In the wider community whether there’s a safe place to ride your bike, or walk, or play, that has a very large influence on whether people can or will be physically active.

One of the things that really I think tells us something – was a clue that there are important influences going on is when we look around the world and not everybody is having the same problem that we are in the United States. Their prevalence of obesity in Japanese women and Swedish women is about 5 percent. It’s almost 40 percent in this country. There’s huge differences and it’s not just genetic because when people come to live in the United States they can get fat just like Americans in general have been getting fat. So it’s very interesting to look at what’s going on in other places. Some of these differences are cultural. I think strong important cultural factors, but then in Sweden and Scandinavia there’s been a very proactive effort by government to promote better health and wellbeing by building recreational vices, supporting good nutrition, much more actively than has been done in this country.

JONATHAN: I remember reading that statistic and it blew my mind because I actually didn’t realize that rates of obesity were so low in those countries and what I think is important for the listeners and the viewers to understand is – and correct me if I’m wrong here, Dr. Willett, but the females in those countries aren’t taking some special new supplement or some new seven day quick fix program or some — just the new thing you hear on the late night infomercial and I would pause it, but again, I could be wrong, but America seems to be the most predisposed or preoccupied with things like counting calories and going to the gym and these almost artificial things, whereas, I would imagine in these other countries somehow they’re staying slim without doing all of those things. How do we make sense of that?

WALTER: Well, I think we’re still learning about some of the details, but one thing pretty clearly is that being not overweight is a strong cultural norm in those countries, but then they created the environment and social (Inaudible 00:32:48) in the cultural context to support that. For instance, in Japan you wouldn’t serve a guest a huge mountain of food on a plate. You would serve a plate with some very nicely prepared and nicely arranged small portion sizes and you’d eat them slowly and with some attention to them – and you wouldn’t in Scandinavia have somebody put a 20-ounce Coke on your plate. They wouldn’t think that that would be a good thing to do. Essentially, they’ve created a culture so that it becomes normal and easy sort of just the default to adopt healthier behaviors. It’s not that people are not conscious and they are in fact, I think if you go to those countries — in my informal focus groups I’ve conducted people are definitely are conscious about their weight, but they’ve created a social context and environment that means that maintaining a weight isn’t an uphill struggle the same way it is everyday for someone here. It’s not easy to do that in this country.

JONATHAN: Brilliant. Well, Dr. Willett, what can we expect next from you? Obviously you’ve been at this for so long you’ve been cranking out thousands of studies. You’ve got many other books again, the most recent one here is “Thinfluence,” what can we expect next?

WALTER: I’m back to research at the moment and of course that’s always been the most about my activity. A lot of what we’re looking at now is the influence of diet during childhood and young adult here on risk of major illnesses later in life, cancer, osteoporosis and fractures and things like that. Until fairly recently, almost all of our research and research done elsewhere has been in somewhat looking under the lamp when we’re studying cancer, we look at the period in life when cancer is occurring, but more and more we’re really realizing that the origins of those cancers often start in childhood and early adult life and that to really understand the full picture, we need to look at the whole life span and that’s turning out to be interesting. We are seeing that diet is having important influences early on that we didn’t see when we started looking at midlife and later.

JONATHAN: Brilliant. Well, Dr. Willett, thank you for all the work you’ve done, the countless lives I know you’ve – dare I say, saved with your research, and I so appreciate you sharing your time with us today.

WALTER: Thank you. It’s good to be able to talk.

JONATHAN: Well, Dr. Willett again, all my thanks. Listeners and viewers, as you undoubtedly know and are in as awe as I am, we’ve been joined by the Chair of the Department of Nutrition at the Harvard School of Public Health, Dr. Walter Willett, who if you’ve read any of my books, you’re very familiar with because I cite him extensively. His most recent book is called, “Thinfluence” and if you want to learn a lot of science about how your environment influences your weight and wellbeing, I would highly recommend checking it out. Remember, this week and every week after, eat smarter, exercise smarter, and live better. We’ll chat with you soon. Bye-bye.

WALTER: Bye.